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Abstract

Background:

The increasing incidence and prevalence of diabetes have led to a strain on health care systems, necessitating innovation in diabetes care delivery and substantial resource allocation for disease management and treatment of complications. Recently, Saudi Arabia has made significant strides in digital transformation, implementing cutting-edge technologies across various sectors, including the health sector.

Aims:

To develop a report that examines the current status, identify challenges and opportunities in implementing diabetes technology solutions for diabetes management, and provide a strategic roadmap for enhancing the accessibility to diabetes technology solutions.

Methods:

The Saudi National Diabetes Center (SNDC) convened a group of experts to develop a comprehensive report that serves a dual purpose. First, it provides a narrative review on insulin pumps and CGMs that are approved by the SFDA and discusses their clinical effectiveness based on local studies. Second, it presents a comprehensive report on the current status and future directions of diabetes technology in Saudi Arabia.

Results:

Our experts identified six major barriers to the adoption of diabetes technology solutions in Saudi Arabia and proposed 14 strategic initiatives that can help overcome these barriers and transform the current overwhelmed diabetes care model into a more innovative, effective, efficient, safe, accessible, and cost-effective model of care.

Conclusion:

While Saudi Arabia offers one of the most diverse ranges of diabetes technology solutions globally, major accessibility barriers persist. The SNDC Diabetes Technology Report is the first report developed primarily for policymakers, regulatory bodies, clinicians, academicians, and industry partners to address these accessibility barriers.

Keywords

diabetes digital health Saudi Arabia insulin pump CGM diabetes technology

Background

Diabetes poses a significant health and economic burden in Saudi Arabia and the Middle East and North Africa (MENA) region, with the region experiencing the highest prevalence rates globally.¹ Saudi Arabia is among the top five countries in the MENA region, and top 10 countries worldwide, in diabetes prevalence among adults with an estimated age-standardized prevalence of 23.1%.¹ The increasing incidence and prevalence of diabetes have led to a strain on the region health care systems, necessitating substantial resource allocation for disease management and treatment of complications. The health burden of diabetes in Saudi Arabia is evident in the rising rates of cardiovascular diseases, renal failure, non-traumatic amputation, and blindness associated with poorly controlled diabetes.² It is estimated that one in two individuals with diabetes who visit diabetes clinics in Saudi Arabia have at least one microvascular complication.² Moreover, the economic impact of diabetes and its complications is substantial, encompassing direct medical costs for the management of diabetes and its complications, and indirect costs due to worsened quality of life, absenteeism and reduced productivity at work, and premature mortality.^3,4 People with diabetes in Saudi Arabia have ten times the health care expenditures compared to those without diabetes.³ Such high prevalence and economic burden of diabetes presents a considerable challenge to the nation’s health care infrastructure and economic development. This underscores the urgent need for developing and implementing more accessible, efficient, and cost-effective strategies for both preventing new cases of diabetes and improving the management of existing ones to prevent diabetes complications.

Over the recent years, Saudi Arabia has made significant strides in digital transformation, implementing advanced technologies across various sectors and launching initiatives like the Ministry of Health (MOH) Vision for E-Health,⁵ highlighting its commitment to becoming a technologically advanced nation. In diabetes, the utilization of continuous glucose monitors (CGMs) and insulin pumps, coupled with smartphone apps and cloud-based platforms, can significantly enhance the quality, accessibility, efficiency, and cost-effectiveness of diabetes management.⁶ These technologies enable real-time glucose monitoring, automated insulin delivery, and data-driven decision making, allowing for more precise and personalized treatment regimens. By providing patients with continuous feedback and health care providers with comprehensive data, diabetes digital health solutions can improve glycemic control, minimize risk of complications, and enhance the overall quality of life among people living with diabetes. Such innovative management strategy is expected to yield significant reductions in health care expenditure associated with diabetes and its complications. Moreover, diabetes technology solutions can bridge geographical barriers, extending specialized diabetes care to remote areas and alleviating the strain on health care facilities. The potential for remote monitoring and virtual consultations can increase the efficiency and safety of health care delivery and reduce the need for frequent in-person visits and potentially lowering the overall health care costs.

In response to the rapidly evolving landscape of diabetes technologies and their transformative potential in diabetes care, this comprehensive report examines the current status, challenges, and opportunities in implementing diabetes technology solutions for diabetes management in Saudi Arabia and provides an in-depth analysis of emerging technologies, implementation frameworks, and evidence-based recommendations. Through this analysis, we aim to bridge the gap between technological innovation and practical implementation while addressing critical aspects of accessibility and clinical outcomes in diabetes care in Saudi Arabia.

Materials and Methods

Setting

As of 2024, the total population of Saudi Arabia exceeds 35 million individuals with approximately 19.6 million Saudi citizens and 15.7 million non-Saudi residents.⁷ Most Saudi citizens with diabetes, including governmental-sector employees, receive care through the public health care sector, where health care services are provided free-of-charge. In contrast, all non-Saudi residents, and some of the private-sector Saudi employees, rely on health insurance coverage provided by their employers, to access health care services. The Saudi health insurance system is relatively young and continues to evolve rapidly. The Council of Health Insurance (CHI) is the governmental body that oversees and regulates the health insurance sector in Saudi Arabia to ensure compliance with policies, quality of services, and dispute resolutions. The Saudi Food and Drug Authority (SFDA) is another key player in the health care system in Saudi Arabia. The SFDA oversees and regulates medical devices to ensure that they meet the safety, quality, and performance standards.^8,9

Methods

This article serves a dual purpose. First, it provides a narrative review on insulin pumps and CGMs that are approved by the SFDA and discusses their clinical effectiveness based on local studies. Second, it presents a comprehensive report on the current status and future directions of diabetes digital health in Saudi Arabia. The two parts were developed primarily for health care policymakers who seek to integrate digital health into national strategies, health care professionals (HCPs) who may utilize these technologies in their clinical practice, academic researchers who advance the field through research and training, and industry partners who develop innovative solutions.

Part 1: Narrative review on insulin pumps and CGMs in Saudi Arabia

A narrative review on the insulin pumps and CGMs available in Saudi Arabia was performed using the following keywords “insulin pump,” “continuous glucose monitoring,” and “diabetes technology” and “Saudi Arabia” alone and in combination to retrieve available local literature from PubMed from January 2019 until January 2024. We limited the search to studies that examined the effectiveness and safety of insulin pumps and CGMs in patients with type 1 and type 2 diabetes in Saud Arabia.

Part 2: Diabetes technology report

To develop this report, the Saudi National Diabetes Center (SNDC) formed a working group of five national experts in diabetes digital health in Saudi Arabia. The working group included endocrinologists, a diabetologist, and representatives from the Saudi Food and Drug Authority (SFDA) and Council of Health Insurance (CHI) who identified the topics that need to be covered in the report. Subsequently, the group collaboratively drafted the report based on the evidence found in the narrative review of literature, clinical experience, and published local and international policies and regulatory documents.

Following this, the drafted report underwent a comprehensive review by the SNDC Scientific Committee composed of adult and pediatric endocrinologists and representatives from 13 health sectors in Saudi Arabia (Ministry of Health, Ministry of Defense, Ministry of Interior, National Guard Health Affairs, King Faisal Specialist Hospital & Research Center, Saudi Red Crescent Authority, Ministry of Education, Saudi Commission for Health Specialties, The Public Health Authority, Presidency of State Security, Federation of Saudi Chambers, SFDA, and CHI). This manuscript does not involve human subjects or primary data collection; therefore, IRB approval was not required.

Results

Part 1: Narrative Review on Insulin Pumps and CGMs in Saudi Arabia

The SFDA-approved insulin pumps and CGMs

Continuous glucose monitors

A continuous glucose monitor (CGM) is a wearable device that continuously monitors interstitial glucose, provides real-time glucose readings, and displays those data on a receiver or smartphone app. In addition, CGMs offer an option to transmit glucose data, through the cloud, to remote caregivers including HCPs. The latter feature empowers people living with diabetes and their HCPs as they practice personalized medicine, makes the clinic visits more efficient and safer, and facilitates telemedicine visits whenever and wherever needed.^10,11 As of September 2024, the date of writing this report, there are 12 CGMs approved by the SFDA as highlighted in Table 1.

Table 1.

Key Features of SFDA-Approved CGMs.

	FreeStyle Libre 2	FreeStyle Libre 3	Dexcom G6	Dexcom G7	Dexcom One+	Guardian connect	Sibionics	AIDEX	RIGHTEST iFree	Sincare iCan	SugarBEAT(company)	POCTech
Approved Age for use, years	4 and older	4 and older	2 and older	2 and older	2 and older	7	18 and older	12	18 and older	18 and older	18-70 years old	14 years and older
Warm-up time (hours)	1	1	2	0.5	0.5	2	1	1	2	2	1	1
Maximum wear time (days)	14	14	10	10.5	10.5	7	14	14	14	15	14	14
Calibrations required (# per day)	0	0	0	0	0	0	0	0	2 calibration during warm-up and 1 calibration/day)	0	Daily	Daily
SFDA-cleared sites	Upper arm	Upper arm	Abdomen & back of the upper arm (indicated for patients age 2 years & older) or the upper buttocks (ages 2-17 years)	Abdomen, back of the upper arms for all; and upper buttocks for 2-6 years old	Abdomen, back of the upper arms for all; and upper buttocks for 2-6 years old	Abdomen and back of Upper arm (14 +); abdomen and upper buttocks (7-13)		Abdomen and upper arm	Arm	abdomen	Upper arm	Upper arm or middle abdomen
Approved in Pregnancy (US FDA, SFDA, EMA)	Yes	Yes	Yes	Yes	Yes	No	No	No	No	No	No	No
MARD, %	9.2	7.8	9	8.2	8.2	10.9	8.83	9.08	8.80%	8.71%	11.92%	9.6%
Display device	Smartphone or reader	Smartphone or reader	Smartphone or reader	Smartphone or reader	Smartphone or reader	Smartphone only	Smartphone and reader	Smartphone or reader	Smartphone	Smartphone	Smartphone	Receiver
Drug interactions	Vit C >500 mg/day	Vit C >500 mg/day	Hydroxyurea	Hydroxyurea	Hydroxyurea	Acetaminophen and hydroxyurea	Possible acetylsalicylic acid, ascorbic acid	Unknown	Unknown	Unknown	Unknown
Integration with insulin pumps, smart pens, caps	No	Yes	t:slim X2	t:slim X2, OmniPod 5, NovoPen 6, and InPen	No	InPen	No	Equil Insulin Pump	No	No	No	No
All-in-one sensor and transmitter (one piece)	Yes	Yes	No	Yes	Yes	No	Yes	No	No	No	No	No
Estimated Cost	$	$	$$	$$	$	$$	$	$	$	$	$	$

Insulin pumps

Insulin pumps have revolutionized the management of diabetes, particularly type 1 diabetes, offering improved glucose control and quality of life for patients. These devices come in various forms, including open-loop pumps and automated insulin delivery (AID) systems. Open-loop pumps require manual input for basal insulin dosing; while AID systems, also known as closed-loop systems, represent the latest advancement, integrating CGMs with insulin pumps to automatically adjust insulin delivery based on real-time glucose readings. Studies have shown that these technological advancements have significantly improved glycemic control (by >10% improvement in time in range), decreased HbA1c levels (by 0.1%-0.9%) and time spent in hyperglycemia, and maintained or decreased time below range.^12
-14 While initial costs of these devices may be higher, the long-term benefits in terms of health outcomes and quality of life suggest that insulin pump therapy, particularly AID systems, could be a cost-effective solution for managing type 1 diabetes.^15
-17

Another way to classify insulin pumps is by whether the pump is tubed or tubeless. Tubeless pumps offer increased convenience with a patch-like design. Some tubeless pumps are open loop and others are automated (ie, AID). Table 2 summarizes the key features of the SFDA-approved insulin pumps as of September 2024, the date of writing this report.

Table 2.

Key Features of SFDA-Approved Insulin Pumps.

	Automated insulin delivery (AID) systems “artificial pancreas”				Open-loop (manual) pumps
	OmniPod 5	Medtronic MiniMed 780G	Tandem X2 control-IQ	Medtrum	OmniPod dash	Accucheck solo	Equil patch pump
Automated Basal Insulin Adjustment	Yes	Yes	Yes	Yes	No	No	No
Automated Correctional Doses	No	Yes	Yes	Yes	No	No	No
Target glucose for automated basal adjustment	110, 120, 130, 140, or 150 mg/dL	100, 110, 120 mg/dL	112.5-160 mg/dL	100, 110, 120 mg/dL	N/A	N/A	N/A
Optional Higher glucose target	150 mg/dL (Activity Mode Target)	150 mg/dL (Temp target)	140-160 mg/dL (Exercise target)	Yes	N/A	N/A	N/A
Optional Lower glucose target	none	none	112.5-120 mg/dl (sleep mode)	Yes	N/A	N/A	N/A
Maximum Capacity (Units of insulin)	200	300	300	200	200	200	200
Wear time (days)	3	3	3	3	3	3	3
CGM compatibility	Dexcom G6	Guardian 4	Dexcom G6 & G7	Medtrum sensor	No integration	No integration	No integration
Updatable Pump Software	Yes	Yes	Yes	Yes	No	No	No
Tubes	No (Patch Pump)	Yes	Yes	No (Patch Pump)	No (patch pump)	No (patch pump)	No (Patch Pump)
Re-charge required	the controller is rechargeable	Battery	Recharge (Micro USB)	Batteries	PDM is rechargeable	The diabetes manager needs to be charged every 2-3 days	Batteries
Approved Age for use, years	2 years	7 years & using 8 units/day or more	6 years	2 years	All ages	2 years	14 years
Cost	Has not been determined	$$$	$$$	$$	$	$	$

Local scientific evidence for the effectiveness, safety, and cost-effectiveness of diabetes technology solutions in Saudi Arabia

Continuous glucose monitors

Type 1 Diabetes

(a) Glycemic Control:

Numerous studies showed that CGMs improve glycemic control in people with T1D.^18
-21 In pediatrics, the use of CGM resulted in a notable reduction in hemoglobin A1c levels from 10.8 to 9.1% over nine months, particularly benefiting those with poor baseline glycemic control.¹⁸ Likewise, adults using CGM for one-year experienced a decrease in hemoglobin A1c from 9.8% to 8.6%,¹⁹ demonstrating the effectiveness of CGM in improving glucose levels across different ages (Table 3).

Table 3.

Summary of Local Studies Examining the Effectiveness and Safety of CGMs and Insulin Pumps in Saudi Arabia.

Continuous glucose monitors (CGMs)
Author	Study design/ follow-up	Number of participants intervention/control	Age	Primary endpoint/objective/outcome	Result	Conclusion	Limitation
Al Hayek and Al Dawish¹⁰	Prospective study/12 weeks	33 with T1D using flash glucose monitoring (n:10 on insulin pump -n: 23 on MDI)	14–21 years	Satisfaction and well-being by use Diabetes Treatment Satisfaction Questionnaire (DTSQ) and the WHO-5 Well-Being Index (WHO-5) Questionnaire	Mean satisfaction score increased from 14.4 at baseline to 32.1 after 12 weeks. the overall well-being percentage score increased from 45.1% at baseline to 93.6% after 12 weeks (p < 0.001).	FSL usage in T1D increased satisfaction and a well-being compared with the SMBS	1-Lack of Control Group. 2-Small Sample Size 3-Single-Center Design 4- Observational study
Alharthi et al²²	Retrospective study/6 weeks	101/TID divided to 1-Attending telemedicine clinic (n: 41 2- Not attended (n:40)	Median age of 23 years	Improvement in glycemic control metrics	Who are attended the clinic: Reduced average glucose from (180 to 159 mg/dl), GMI improved (from 7.7% to 7.2%), TIR increased from (46% to 55%), who are not attended the clinic no significant changes in glycemic control.	Effectiveness of telemedicine in T1D using CGM	1-Short Follow-Up Period. 2-Selection bias in one center
Al Hayek et al²¹	Prospective Study-Single cohort study/ 12 weeks	47/ T1D using insulin pump	13-21 years	Diabetes self-management behaviors and glycemic indicators before and after the implementation of the FSL2 system	Baseline: HbA1c level was 8.3%, at 12 weeks: 7.9% (p = 0.064). TIR was 59.8 ± 12.6%, TAR 32.7 ± 11.6%, TBR 7.5 ± 4.3%, mean glycemic variability, standard deviation 63.2 ± 12.5 mg/dL, and the coefficient of variation 41.3 ± 11.4%. Total diabetes self-management score at the baseline 2.7 reaching 6.4 after 12 weeks. (P < .001)	Improved Diabetes self management+Glycemic Control	1-Short Follow-up Duration: 2-Dropout Not Mentioned. 3-Limited Risk Factors Assessed, 4- Single and observational study
Al Hayek et al²³	Prospective Study-Single cohort study/12 weeks	52/T2D on MDI using FSM2	20-75 years	Change of A1C and Satisfaction after FDM2 insertion	HbA1c improved by 0.44% from 8.22%±0.69 (mean at baseline to 7.78% at 12 weeks, P < .001 Two-fold, statistically significant improvement in glucose monitory satisfaction survey, and double in total treatment satisfaction	Glycemic control and satisfaction are clinically significant after insertion FSL2	1- Not controlled cofounders. 2- type of the study. 3- Lack of control group and one center research.
Al-Harbi et al²⁰	Observational study	6097 readers and 35 747 sensors.	No specific age	Correlation between number of scanning with HbA1C, TIR, Glucose metrics	Highest scanning frequency (32 scans/day) achieved 8.47% HbA1c, 46.4% TIR, 75.0 mg/dL SD; lowest (5.2 scans/day) 9.77%, 32.8%, 94.9	All parameters of diabetes control are improved with higher numbers of scanning	1-Lack of demographic and clinical data, eg, age- type of diabetes2- Absence of longitudinal analysis
Alyusuf et al²⁴	Observational study/12 months	116/TID 35% on insulin pump using FGM1	Mean age 26 years	Number of scanning to glycemic indices	1-Frequent scanning >10 scan/day: TIR: Increased from 43.5% to 54.5% at month 6 and to 49% at month 12.TAR: Decreased from 49% to 40.5% at month 6 and 45% at month 12.2-Infrequent scanningTIR (42% to 52%) and TAR (51% to 44%) were noted only by month 12:	Frequent scanning linked to faster and more substantial improvements of glucose control.	1-Unmeasured Factors as Behavioral, psychosocial were not assessed2- retrospective study, single center.
Alharbi et al¹⁹	Retrospective cohort study/Multicenter²⁵	1307/ T1D	4-18 years	HbA1C at 3, 6 and 9 months	Baseline HbA1C 10.8% reduced to 9.8% at 3 months, 9.2% at 6 months and 9.1% at 9 months (P < .001)	Flash glucose monitoring significantly reduces HbA1c levels	1-Absence of Detailed Glucose Metric. 2-Limited Clinical Information
Al Hayek and Al Dawish²⁶	Retrospective cohort study/one year	93 /T2D	Mean age 48 years	Effectiveness and sustainability of isCGM in T2DM patients not on intensive insulin	HbA1c improved significantly, from a pre-isCGM mean of 8.3 to 8.1% at 90 days, and further to 7.9% by the last 90 days (both with P < .001)	Use of isCGM helps reduce HbA1c levels in T2DM patients not on intensive insulin,	1-HbA1c Range only(7-10%) 2-Single-Center Design
Alsahli et al²⁷	Retrospective design/one year	98/ T1D on MDI using FSL	> 14 years	HBA1C, Satisfaction and Quality of life	HbA1C reduced from 9.83% to 8.6%. Satisfaction Over 85% Quality of life: 70.4%	Significantly enhance satisfaction, quality of life and glycemic control	1-Lack of a detail adherence to FSM 2- single, observational study
Altamimi et al²⁸	Cross- sectional study/ 6 months	317/ T1D	Mean age 34 years	Glycemic control and Quality of life	Baseline a1c mean of 8.79%±1.63%- Ater 3 months; a1c mean of 8.24%±1.30% (P < .001), and continue for six months	CGM significantly improved diabetes control, while improved quality of life was not significant.	1- recall bias 2-study design
Insulin pump
Author	Study design/follow-up	Number of participants intervention/control	Age	Primary endpoint/objective/outcome	Result	Conclusion
Al Shaikh et al²⁹	Cross-sectional study/6 months	68 with T1D/ n:34 on MDI and n: 34 on CSII	0-18 years	Quality of life	Insulin pump group has a significant better scoring in 3 dimensions in Quality of life (Diabetes Problems, Treatment Problems, Worry Problems)	Insulin pump therapy improves quality on life	1-Gender Imbalance. 2-single and observational study 3-lack of longitudinal data
Babiker et al³⁰	Retrospective cohort study/3 years(2016-2018)	168 with T1D / n: 129 on MDI and n: 39 on CSII	< 18 years	HbA1c at 1-2 and 3 years	CSII lower HbA1c 3-year compare to MDI, follow-up period: 8.1% versus 10.1, P-value < .001 at 1 year, 7.5% versus 10.1% at 2 years, P-value < .001, 8.9% versus 10.3% at 3 years, P-value = .033.	Treatment with CSII resulted in lower HbA1c compared to MDI, which was continued to a 3-year period	1-Small numbers compared to control. 2-single tertiary center not represent the community 3—retrospective 3 years introduced positional bias
Brazanji et al³¹	A cross-sectional study	64 with T1D	Mean age 25 years	HbA1C level before and one years after the insulin pump insertion	The average HbA1C before is 9.5% ± 2%; and the average HbA1C after is 8.2% ± 1.3%. HbA1C average is decreased by 1.4 with a P-value <.001	Reduction in HbA1C significantly	1- secondary data extracted from existing records. 2- Not justified other cofounder. 3-single center. 4-not mention type of metronic pump was used
Wannes et al³²	Case report/two successive Ramadan seasons	shifted from SAP-PGLM to AHCL	11 years old	Effectiveness of these two insulin delivery systems during fasting	TIR 58% pre Ramadan reach to 60% to 72% in Ramadan in the SAP-PGLM in 2021 vs TIR 70% pre Ramadan reach to 75% during Ramadan in the AHCL in 2022 average blood glucose in Ramadan is 183 mg/dL in the SAP-PGLM VS 135 mg/dL in the AHCL	AHCL system provides statistically superior glycemic control	1-single-case design. 2-Confounding factors is not address
Wannes et al³³	Observational cohort study	19 with T1D (n: 8 on HCL+(n: 11 on AHCL)	8-16 years	Effectiveness, safety HCL Glycemic control metrics, through assessment pre Ramadan and During Ramadan, categorized to fasting 11 vs non fasting 8	11 out 18 are fasted, all patients has the same result pre Ramadan vs Ramadan as: TIR (72.9 ± 8.1 vs 74.5 ± 6.8, P = .17), the same TER (1.6 ± 1.3 % vs 2.4 ± 2.1, P = .076),the same TAR (25.5 ± 8.1 vs 23.1 ± 6.9, P = .062)	No significant different between fasting vs non-fasting and S-HCL 670G vs AHCL 780G system during Ramadan	1-the small sample size. 2-lack of control group 3-insulin requirements and dietary habits were not extensively controlled. 4-no long-term follow-up beyond Ramadan to assess the lasting effects of fasting on glycemic c
Alnaim et al³⁴	Retrospective cohort study/ 2 years(2020-2022)	351 with T1D/n: 316 on MDI and n:35 on CSII	1-14 years	Change of A1C for nine months/events of DKA	The average HbA1c for those on the MDI regimen was 9.6 ± 2.2%, VS 8.8 ± 2.5% for those on CSII, with a p-value of 0.045 — DKA, (12%) of patients with diabetes on the MDI regimen experienced DKA, compared to (11.4%) of those on the CSII, P-value: .9	Use of CSII lead to better glycemic control	1- patients characteristics not equally distributed. 2- other cofounder not will adjusted as education, motivation, family support
Al-Sofiani et al²⁵	Retrospective observational study (Gulf region)	449 with T1D on MiniMed 780G (AHCL)	247 < 15 y (55%) 202 > 15 y (45%)	Metrics of glycemic control before, during after Ramadan	Overall, 1-Pre Ramadan: TIR: 71.7%- TAR 25.7%- TER 2.6%.2- During Ramadan: TIR: 70.6%- TAR 27.2%- TER 2.3%3- 2- After Ramadan: TIR: 70.5%- TAR 27.%- TER 2.5% (P < .0001 for all).	AHCL maintained a reassuring safety profile, with effectiveness	1- missing socio-demographic data 2- Potential Self-Reporting Bias
Al-Sofiani et al³⁵	Prospective, noninterventional study	294 with T1D/ 5 groups: 1-AID(n: 62). 2-Conventional pump+MDI(n:37). 3-Pump+SMBS(n:8). 4-MDI+CGM(n:155). 5-MDI+SMBS(n:32).	Mean age 22 years	Outcomes for different modalities of diabetes treatment during Ramadan	53% of AID users meeting the dual goal of sustained fasting and TIR ≥ 70%, compared to only 3% of conventional pump users and 44% of MDI + CGM users	\AID systems are a safe and the best option for T1D management during Ramadan	1-Other Confounding not adjusted as physical activities and dietary habit.

(b) Quality of Life.

For younger individuals with T1D (ages 14-21), the transition from the conventional fingerprick method to CGM has significantly improved the mental well-being and treatment satisfaction of these individuals. The WHO-5 Well-Being Index in one study increased from 45.1% to 93.6%, and the Diabetes Treatment Satisfaction Questionnaire (DTSQ) score increased from 14.4 to 31.7, indicating improved psychological health and satisfaction.²⁷ Likewise, during the COVID-19 lockdown, patients with T1D who had access to telemedicine and CGM were more likely to maintain good glycemic control, highlighting the key role of CGM and telemedicine in providing remote health care services that are essential for continuity of care and quality of life²² (Table 3).

Type 2 Diabetes on Multiple Daily Injections (MDI)

(a) Glycemic Control:

A 12-week study revealed that patients with T2D on MDI who transitioned to CGM experienced a significant improvement in hemoglobin A1c, with levels dropping from 8.2% to 7.8%.²³ Furthermore, the frequency of hypoglycemic events decreased from an average of 4.4 to 1.2 per month, indicating the role of CGM in stabilizing glucose levels and minimizing adverse events in insulin-dependent T2D patients²³ (Table 3).

(b) Quality of Life:

Patients with T2D on MDI reported increased satisfaction with glucose monitoring using CGM, as reflected in improved DTSQ and Glucose Monitoring Satisfaction Survey scores. These findings highlight the role of CGM in enhancing self-management confidence and improving overall quality of life in people with T2D on MDI²⁷ (Table 3).

Type 2 Diabetes Not on Insulin Therapy

A longitudinal one-year study demonstrated that people with T2D who are on oral glucose-lowering medications and utilize CGM experienced a sustained reduction in Hemoglobin A1C levels from an average of 8.3% to 7.9%.²⁶ These findings suggest that CGM is a valuable tool for glycemic management even in patients with T2D who are not requiring intensive insulin therapy (Table 3).

Insulin pumps

People with type 1 diabetes during regular days

Comprehensive analyses comparing insulin pump therapy to MDI in both pediatric and adult populations with T1D in Saudi Arabia revealed the following findings (Table 3):

(a) Quality of Life:

Patients using insulin pumps reported improved health-related quality of life, better scores in diabetes management satisfaction, fewer treatment-related challenges, and reduced anxiety about glucose control.²⁹

(b) Glycemic Control:

Studies revealed that insulin pump use offers better glycemic control, with consistently lower A1C levels and less glycemic variability compared to MDI.^30,31,34

While insulin pump users had better adherence and overall well-being, they experienced increased concern about disease management.²⁹

(d) Long-Term Benefits:

Insulin pump users demonstrated sustained HbA1c improvement over extended period of time.³⁰

People with type 1 diabetes during Ramadan fasting

Studies on the Medtronic MiniMed 780G AID systems showed safe and effective glycemic control during Ramadan fasting. The use of this system was associated with better glucose control, higher number of days fasted, and reduced hypoglycemia risk compared to MDI and other modalities of treatment.^32,33 Al-Sofiani et al²⁵ showed that 449 users of the AID system in the Gulf region were able to maintain stable glycemic control during Ramadan within the international consensus targets for TIR (average TIR of 70.7%) compared to the months before and after Ramadan. In another prospective Saudi study, users of AID fasted more days of Ramadan (median days the fast was broken because of diabetes was only two days) and had higher TIR during Ramadan (average TIR: 73%) compared to users of other modalities of T1D treatment.³⁵ These findings provide additional benefits of the AID system in Saudi Arabia and the MENA region.

Part 2: Diabetes Technology Report

Patients’ journey to diabetes technology solutions: Navigating the accessibility framework in Saudi Arabia

The journey of people living with diabetes to accessing diabetes technology in Saudi Arabia varies significantly depending on whether they are treated in the public or private health sector. Figure 1 demonstrates the typical pathway to insulin pump therapy for a person with diabetes in Saudi Arabia. As of now, the pathway to acquiring CGMs is not completely streamlined neither in the private nor in the public health sector. Most insurance companies and public clinics develop their own guidelines for who is eligible for CGM use. These guidelines vary significantly because of the lack of national guidance. Access to diabetes technology solutions in Saudi Arabia is generally more favorable among individuals with private insurance who live in urban areas, compared to those who have no insurance or are living in rural regions. In rural and underserved areas, access to diabetes technology remains extremely limited due to disparities in infrastructure, resource availability, and insurance coverage. Moreover, the proportion of people with poorly controlled glucose and complications is higher in those who reside in rural areas of Saudi Arabia compared to those living in urban areas.^58,59 Although local data on the utilization of diabetes technology solutions remains limited, the ability to remotely transmit data through the cloud offers a promising avenue for digital health solutions and telehealth to address the current disparities linked to area of residence, limited resources, shortage of specialists, and patients’ social determinants of health.⁶⁰ Given the documented regional differences in diabetes and its complications in Saudi Arabia, particularly affecting remote and rural areas, diabetes digital tools to screen for diabetes and its complications present a valuable solution to improve early detection and care.^61
-63 Screening for retinopathy remains below target nationwide (58%) due to various reasons including the limited access to ophthalmologists especially in remote areas.^64
-66 A systematic review showed high prevalence of diabetic retinopathy in Saudi Arabia which varies widely depending on population characteristics and diagnostic methods and can reach up to 88.1%.⁶⁷ Vision-threatening diabetic retinopathy was found in 4% to 17% of patients.^68,69 Utilizing telemedicine and diabetes digital tools provides an opportunity to expand the screening programs for diabetes and its complications beyond large cities and tertiary medical centers.

Figure 1.

Patients’ journey to insulin pump therapy in Saudi Arabia at the moment.

In this section, we highlight the strengths and limitations of the public and private health sectors in Saudi Arabia and how this may affect the patients’ journey to diabetes technology.

Public sector

As of today, most people with diabetes in Saudi Arabia are cared for by the public health care sector, where they receive free-of-charge health care services, including diabetes medications and some basic digital health solutions. However, they often face longer waiting times, limited access to advanced diabetes technology solutions, and potential bureaucratic hurdles in obtaining advanced innovations such as automated insulin delivery (AID) systems and CGMs. Many diabetes centers in the public sector offer a limited quantity of insulin pumps. Many of these pumps are open-loop pumps (as opposed to AID systems), where the pump is not integrated with a CGM sensor. Local experts estimate the utilization rate of insulin pumps among people living with T1D in Saudi Arabia to be <1% to 3%. Due to the limited availability of insulin pumps in the public clinics and the long waiting list of patients, public clinics often develop very stringent criteria for people with T1D who they would consider eligible for insulin pumps. These criteria often include having a hemoglobin A1C of less than 7 or 7.5% for example, excluding patients with diabetes who live with poorly controlled glucose and may arguably be in more need for insulin pumps.

Likewise, CGMs are available in limited quantities in the public sector and is only dispensed by endocrinologists or family physicians/internists who have an additional training in diabetes. Interruption of CGM supply is a frequent issue that people with diabetes face in the public sector. As it is the case for insulin pumps, public clinics have their own stringent criteria for dispensing CGMs, albeit more relaxed criteria than those used for insulin pump therapy.

Private sector

The private sector, on the other hand, offers quicker access to diabetes medications and advanced diabetes technologies. While insurance coverage in the private sector is often perceived as advantageous, it can sometimes paradoxically become a barrier to accessing diabetes technology devices. Despite the potential for more comprehensive coverage, private insurers may implement stringent criteria and complex approval processes for diabetes digital solutions including CGMs and insulin pumps. These barriers can include restrictive eligibility requirements, caps on coverage for specific devices, or excluding diabetes technology devices from the insurance policy. To regulate this, the Council of Health Insurance (CHI) has issued a policy for insurance coverage of insulin pumps (Figure 2). This policy, however, has several limitations and is expected to be updated in the future.

Figure 2.

CHI policy used by insurance companies to reimburse insulin pumps in the private sector.

Likewise, insurance coverage for CGMs is limited in many insurance companies and there is no official guidance by CHI on who among people with diabetes should be reimbursed for CGM. This gap in policy is being realized by CHI and is expected to be addressed in the near future.

For other digital health solutions, the Ministry of Health has published national regulations for the use of telehealth services.⁷⁰ Likewise, the National Health Information Center, Saudi Health Council has developed guidelines for telehealth applications in clinical practice.⁷¹ These regulations are nationwide and applicable to the public and private sectors.

Insights from global strategies and best practices

Globally, the coverage and accessibility of diabetes digital solutions such as CGMs and insulin pumps remain a complex issue. While these technologies have proven to significantly improve diabetes management and quality of life for many patients, their adoption is often hindered by factors such as high costs, limited health care budgets, varying reimbursement policies, and limited specialized health care professionals and diabetes centers. Many countries are grappling with the challenge of balancing the intermediate- to long-term health benefits and cost savings of these technologies against their immediate financial impact on health care systems.^72
-74 As a result, eligibility criteria for coverage often prioritize specific groups of patients, such as those with poorly controlled diabetes, recurrent acute or chronic complications, etc.^75,76 The disparity in access to diabetes technology solutions not only exists between countries but also within countries, reflecting broader socioeconomic inequalities in health care access. As diabetes prevalence continues to rise globally, policymakers and health care systems in developed countries started to realize the need to adopt a strategy of “paying more upfront for future savings.” As a result, insurance coverage for these technologies and public sector support have been recently broaden in many countries to make these life-changing technologies more widely available to those who need them most. Supplemental Table 1 list the coverage and reimbursement criteria for CGMs and insulin pumps from select countries.^77
-82

Conclusions (the Roadmap to Improving Accessibility to Diabetes Digital Health in Saudi Arabia)

Both the public and private health care sectors in Saudi Arabia have made strides in improving diabetes care, but challenges remain in ensuring equitable access to diabetes technology across the country. The public sector’s strength lies in its broad reach and affordability, while the private sector excels in offering rapid access to innovations. Bridging the gap between these two sectors, improving coordination, and addressing barriers to access to diabetes technology solutions in both sectors is crucial in improving the overall quality of diabetes care and reducing the health and economic burden of diabetes on individuals and the overall health care system. The current disconnects between the two health sectors and gaps in their policies not only frustrate patients and health care professionals but also undermine the potential health benefits and long-term cost savings that these digital solutions can offer. We believe the Saudi health care system needs to address the six barriers impeding access to digital health solutions for diabetes management and implement the 14 initiatives proposed in Table 4 according to the roadmap and timeline highlighted in Figure 3.

Table 4.

Current Barriers to Accessing Diabetes Technology Solutions in Saudi Arabia and Proposed Strategies to Overcome These Barriers.

Barriers	Proposed strategies
1. High Cost of technology	1. Utilize the Saudi’s purchasing power, considering the high number of people living with diabetes in Saudi Arabia. This purchasing power creates a substantial market for diabetes management and diabetes technologies. This leverage provides the government and private insurances with purchasing power to negotiate prices, influence product penetration into the country, and improve the technology affordability and accessibility. 2. Localize the production of diabetes digital solutions. This could potentially lower the costs of diabetes technology. 3. Increase funding and allocate more resources for the utilization, and eventually local production, of diabetes digital solutions
2. Shortage of endocrinologists, diabetologists, and specialized health care professionals	4. Encourage and incentivize medical graduates to pursue Endocrinology as their specialty of training and practice. 5. Establish a diabetes technology training programs for health care professionals who are interested in learning more about diabetes digital health 6. Provide incentives to health care professionals who utilize diabetes digital tools such as insulin pumps and CGMs (eg, allow billing for CGM and pump initiation, reading and interpreting CGM and pump reports, etc) 7. Enforce a policy that mandates insurance coverage for diabetes educator visits
3. Limited awareness about the availability, benefits, and effective utilization of diabetes digital solutions	8. Establish national initiatives aimed at raising the awareness about the benefits and effective use of diabetes technology among health care professionals and patients.
4. Lack of comprehensive policies and regulations to facilitate the accessibility of diabetes digital solutions	9. Establish national strategies and policies that promote the accessibility and affordability of diabetes technology10. Develop quality and safety standards to ensure that diabetes digital solutions used in Saudi are safe and effective (eg, real-world evidence, patient registries, pre-approval and post-marketing surveillance, etc)11. Enforce the concept of real-world evidence and mandate this on industry12. Leverage the well-established digital infrastructure in Saudi Arabia.
5. Lack of interoperability of diabetes digital solutions and integration with electronic health records (HER)	13. National efforts to establish local standardized data-sharing and EHR integration protocols is ongoing but needs to be accelerated. Local mHealth solutions (such as Sehaty, Wasfaty, Ehalati, and Karaz digital solutions) can be scaled and integrated to provide a local digital infrastructure for integration.
6. Limited local studies that examine the clinical and cost-effectiveness of diabetes digital solutions in Saudi Arabia	14. Foster partnership between industry and academic and research institutions to conduct local clinical trials and real-world studies on the technology safety, effectiveness, clinical outcomes, and cost effectiveness. Moreover, local studies are needed to examine the impact of cultural and social determinants of health on the utilization and outcomes of diabetes digital solutions in Saudi Arabia.

Figure 3.

Roadmap to improving accessibility to diabetes technology solutions in Saudi Arabia.

Supplemental Material

sj-docx-1-dst-10.1177_19322968251370756 – Supplemental material for Diabetes Technology in Saudi Arabia: Current Status and Future Directions

Supplemental material, sj-docx-1-dst-10.1177_19322968251370756 for Diabetes Technology in Saudi Arabia: Current Status and Future Directions by Mohammed E. Al-Sofiani, Abdulhalim M. Al-Murashi, Nada A. Al-Agil, Azzam O. Al-Othman, Shahad Y. Al-Faris and Ahmed M. Al-Enzi in Journal of Diabetes Science and Technology

Footnotes

Acknowledgements

We extend our sincere gratitude to the Saudi National Diabetes Center (SNDC) team for giving us the opportunity to contribute to advancing diabetes digital health in Saudi Arabia. Special acknowledgment goes to the dedicated health care professionals, researchers, and people living with diabetes in Saudi Arabia. We also appreciate the editorial support by Dr Sahar Alharthi and administrative support by the SNDC staff: Ms Malak Al-Ateeq and Ms Saja Alhosan who facilitated the smooth coordination between different team members, departments, and stakeholders.

Abbreviations

AID, automated insulin pump; CGM, continuous glucose monitoring; CHI, Council of Health Insurance; CSII, continuous subcutaneous insulin infusion; DTSQ, Diabetes Treatment Satisfaction Questionnaire; EBP, essential benefit package; GMI, glycemic management indicators; HbA1c, hemoglobin A1C; HCP, health care professional; HTA, health technology assessments; IQ, intelligence quotient; MDI, multiple daily injection; MOH, Ministry of Health; NHS, National Health Services; NICE, National Institute for Health and Care Excellence; SFDA, Saudi Food and Drug Authority; T1D, type 1 diabetes; T2D, type 2 diabetes.

Declaration of Conflicting Interests

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MEA has served on an advisory panel for Abbott, Medtronic, Insulet, VitalAire, and Sanofi; has received honoraria for speaking and consultancy from Abbott, Eli Lilly, Medtronic, Novo Nordisk, Sanofi, and VitalAire; and has received research fund from Medtronic and Sanofi. All other authors have no conflicts of interest to disclose.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Mohammed E. Al-Sofiani

Ahmed M. Al-Enzi

Supplemental Material

Supplemental material for this article is available online.

References

IDF. IDF Diabetes Atlas. 11th ed. International Diabetes Federation; 2025. https://diabetesatlas.org/media/uploads/sites/3/2025/04/IDF_Atlas_11th_Edition_2025.pdf. Accessed August 20, 2025.

El-Kebbi

Bidikian

Hneiny

Nasrallah

. Epidemiology of type 2 diabetes in the Middle East and North Africa: challenges and call for action. World J Diabetes. 2021;12(9):1401-1425. https://pubmed.ncbi.nlm.nih.gov/34630897/. Accessed February 24, 2025.

Alnaim

Alrsaheed

Alkhateeb

Aljaafari

Alismail

. Prevalence of microvascular complications among patients with type 2 diabetes mellitus who visited diabetes clinics in Saudi Arabia. Saudi Med J. 2023;44(2):211-217. https://smj.org.sa/content/44/2/211. Accessed October 17, 2023.

AlHarbi

Othman

Nahari

, et al. Burden of illness of type 2 diabetes mellitus in the kingdom of Saudi Arabia: a five-year longitudinal study. Adv Ther. 2024;41(3):1120-1150. doi:10.1007/s12325-023-02772-y.

Alhowaish

. Economic costs of diabetes in Saudi Arabia. J Family Community Med. 2013;20(1):1-7. doi:10.4103/2230-8229.108174.

Ministry of Health. National E- Health Strategy—Ministry Vision “e-Health..” Ministry of Health; 2019. https://www.moh.gov.sa/en/Ministry/nehs/Pages/default.aspx. Accessed August 20, 2025.

Al-Sofiani

. Chapter 18: Diabetes digital health and telehealth in the Middle East. In: Klonoff

Kerr

Weitzman

, eds. Diabetes Digital Health and Telehealth. Cambridge, MA: Academic Press; 2022:229-242. doi:10.1016/B978-0-323-90557-2.00004-2.

General Authority of Statistics. Population estimates publication 2024. https://www.stats.gov.sa/documents/20117/2067012/Population+Estimates+Statistics+2024+EN.pdf/9b71e303-5fd9-19cb-9913-850a9d521639?t=1738859947691. Published 2024. Accessed February 24, 2025.

Saudi Food and Drug Authority. Laws and regulations. https://sfda.gov.sa/en/regulations?tags=3. Published 2025. Accessed February 25, 2025.

10.

Al Hayek

Al Dawish

. The potential impact of the FreeStyle Libre flash glucose monitoring system on mental well-being and treatment satisfaction in patients with type 1 diabetes: a prospective study. Diabetes Ther. 2019;10(4):1239-1248. doi:10.1007/s13300-019-0616-4.

11.

Wood

O’Neal

Furler

Ekinci

. Continuous glucose monitoring: a review of the evidence, opportunities for future use and ongoing challenges. Intern Med J. 2018;48(5):499-508. https://pubmed.ncbi.nlm.nih.gov/29464891/. Accessed August 20, 2025.

12.

Saudi Food and Drug Authority. Saudi vigilance-safety alerts. https://ade.sfda.gov.sa/fsca/publishlist. Accessed February 25, 2025.

13.

Sherr

Heinemann

Fleming

, et al. Automated insulin delivery: benefits, challenges, and recommendations. A Consensus Report of the Joint Diabetes Technology Working Group of the European Association for the Study of Diabetes and the American Diabetes Association. Diabetologia. 2022;66(1):3-22. doi:10.1007/s00125-022-05744-z.

14.

Phillip

Nimri

Bergenstal

, et al. Consensus recommendations for the use of automated insulin delivery (AID) technologies in clinical practice. Endocr Rev. 2022;44(2):bnac022. https://pubmed.ncbi.nlm.nih.gov/36066457/. Accessed August 20, 2025.

15.

Considine

Sherr

. Real-world evidence of automated insulin delivery system use. Diabetes Technol Ther. 2024;26(suppl 3):53-65. doi:10.1089/dia.2023.0442.

16.

Fox

Ware

Boughton

, et al. Cost-effectiveness of closed-loop automated insulin delivery using the Cambridge hybrid algorithm in children and adolescents with type 1 diabetes: results from a multicenter 6-month randomized trial. J Diabetes Sci Technol. 2024;66(1):982-991. doi:10.1177/19322968241231950.

17.

Adolfsson

Heringhaus

Sjunnesson

Mehkri

Bolin

. Cost-effectiveness of the tandem t: slim X2 with control-IQ technology automated insulin delivery system in children and adolescents with type 1 diabetes in Sweden. Diabet Med. 2024;41(11):e15432. doi:10.1111/dme.15432.

18.

Biskupiak

Ramos

Levy

, et al. Cost-effectiveness of the tubeless automated insulin delivery system vs standard of care in the management of type 1 diabetes in the United States. J Manag Care Spec Pharm. 2023;29(7):807-817. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10394185/. Accessed August 20, 2025.

19.

Alharbi

Albunyan

Al Nahari

, et al. Measuring the impact of flash glucose monitoring in a pediatric population in Saudi Arabia: a retrospective cohort study. Diabetes Ther. 2022;13(6):1139-1146. doi:10.1007/s13300-022-01224-0.

20.

Al-Harbi

Albunyan

Alnahari

, et al. Frequency of flash glucose monitoring and glucose metrics: real-world observational data from Saudi Arabia. Diabetol Metab Syndr. 2022;14(1):66. doi:10.1186/s13098-022-00831-y.

21.

Al Hayek

Robert

Al Dawish

. Effectiveness of the FreeStyle Libre 2 flash glucose monitoring system on diabetes-self-management practices and glycemic parameters among patients with type 1 diabetes using insulin pump. Diabetes Metab Syndr. 2021;15(5):102265. doi:10.1016/j.dsx.2021.102265.

22.

Alharthi

Alyusuf

Alguwaihes

Alfadda

Al-Sofiani

. The impact of a prolonged lockdown and use of telemedicine on glycemic control in people with type 1 diabetes during the COVID-19 outbreak in Saudi Arabia. Diabetes Res Clin Pract. 2021;173:108682. doi:10.1016/j.diabres.2021.108682.

23.

Al Hayek

Al Dawish

El Jammal

. The impact of flash glucose monitoring on markers of glycaemic control and patient satisfaction in type 2 diabetes. Cureus. 2021;13(6):e16007. doi:10.7759/cureus.16007.

24.

Alyusuf

Alharthi

Alguwaihes

Jammah

Alfadda

Al-Sofiani

. Predictors of use and improvement in glycemic indices after initiating continuous glucose monitoring in real world: data from Saudi Arabia. Diabetes Metab Syndr. 2022;16(2):102416-102416. doi:10.1016/j.dsx.2022.102416.

25.

Al-Sofiani

Petrovski

Shaikh

, et al. The MiniMed 780G automated insulin delivery system adapts to substantial changes in daily routine: lessons from real world users during Ramadan. Diabetes Obes Metab. 2023;26(3):937-949. doi:10.1111/dom.15389.

26.

Al Hayek

Al Dawish

. Use of flash glucose monitoring and glycemic control in patients with type 2 diabetes mellitus not treated with an intensive insulin regimen: 1-year real-life retrospective cohort study. Adv Ther. 2023;40(6):2855-2868. doi:10.1007/s12325-023-02508-y.

27.

Alsahli

Alalwan

Aburisheh

, et al. Assessing satisfaction, quality of life, and HbA1c changes in type 1 diabetes patients who are using FreeStyle Libre glucose monitoring. J Family Med Prim Care. 2024;13(6):2367-2374. doi:10.4103/jfmpc.jfmpc_1630_23.

28.

Altamimi

Moneer Alqeraf

. Effectiveness of continuous glucose monitoring in glucose control and quality of life among type 1 diabetic patients in Madina city: a cross-sectional study. Cureus. 2024;16(7):e65100. doi:10.7759/cureus.65100.

29.

Al Shaikh

Al Zahrani

Qari

, et al. Quality of life in children with diabetes treated with insulin pump compared with multiple daily injections in tertiary care center. Clin Med Insights Endocrinol Diabetes. 2020;13:1179551420959077. doi:10.1177/1179551420959077.

30.

Babiker

Alammari

Aljuraisi

, et al. The effectiveness of insulin pump therapy versus multiple daily injections in children with type 1 diabetes mellitus in a specialized center in Riyadh. Clin Med Insights Endocrinol Diabetes. 2022;15:11795514221128495. doi:10.1177/11795514221128495.

31.

Brazanji

Al-Nafisi

. Effectiveness of the insulin pump on type 1 diabetes in controlling HbA1C in Riyadh, Saudi Arabia. Med Sci J. 2022;26(127):1-8. doi:10.54905/disssi/v26i127/ms369e2441.

32.

Wannes

Al Qusayer

El Abed

Ben Fredj

. Insulin pump therapy and glucose control during Ramadan fasting in an adolescent with type 1 diabetes: from an open-loop sensor-augmented pump therapy with predictive low-glucose management to an advanced hybrid closed-loop system. Acta Diabetol. 2023;60(6):851-855. doi:10.1007/s00592-023-02049-4.

33.

Wannes

Gamal

Fredj

, et al. Glucose control during Ramadan in a pediatric cohort with type 1 diabetes on MiniMed standard and advanced hybrid closed-loop systems: a pilot study. Diabetes Res Clin Pract. 2023;203:110867-110867. doi:10.1016/j.diabres.2023.110867.

34.

Alnaim

Al Ghadeer

Al-Bunyan

, et al. Effectiveness of insulin pump therapy versus multiple daily injections for glycemic control and rate of diabetic ketoacidosis among children with type 1 diabetes mellitus. Cureus. 2024;16(2):e54123. doi:10.7759/cureus.54123.

35.

Al-Sofiani

Alharthi

Albunyan

Alzaman

Klonoff

Alguwaihes

. A real-world prospective study of the effectiveness and safety of automated insulin delivery compared with other modalities of type 1 diabetes treatment during Ramadan intermittent fasting. Diabetes Care. 2024;47(4):683-691. doi:10.2337/dc23-1968.

36.

Al-Sofiani

Alyusuf

Alharthi

Alguwaihes

Al-Khalifah

Alfadda

. Rapid implementation of a diabetes telemedicine clinic during the coronavirus disease 2019 outbreak: our protocol, experience, and satisfaction reports in Saudi Arabia. J Diabetes Sci Technol. 2020;15(2):193229682094709. https://pubmed.ncbi.nlm.nih.gov/32762362/. Accessed August 20, 2025.

37.

Al-Sofiani

AlMesned

Bafadel

Alguwaihes

Alfadda

. The impact of a prolonged lockdown and utilization of diabetes telemedicine on cardiometabolic health in people with diabetes during the COVID-19 outbreak in Saudi Arabia. Prim Care Diabetes. 2022;16(5):644-649. https://pubmed.ncbi.nlm.nih.gov/35773134/. Accessed July 29, 2022.

38.

Aman Allah

Malibarey

Bin Baz

Alsalmi

Alkattan

Attar

. The impact of telehealth on glycemic control in people diagnosed with type 2 diabetes: a retrospective cohort study. Saudi J Health Syst Res. 2025;5:55-63. doi:10.1159/000544061.

39.

Tourkmani

AlHarbi

Bin Rsheed

, et al. The impact of telemedicine on patients with uncontrolled type 2 diabetes mellitus during the COVID-19 pandemic in Saudi Arabia: findings and implications. J Telemed Telecare. 2021;29(5):1357633X2098576. https://pmc.ncbi.nlm.nih.gov/articles/PMC10195693/. Accessed August 20, 2025.

40.

Al-Mutairi

Alshabeeb

Abohelaika

Alomar

Bidasee

. Impact of telemedicine on glycemic control in type 2 diabetes mellitus during the COVID-19 lockdown period. Front Endocrinol (Lausanne). 2023;14:1068018. doi:10.3389/fendo.2023.1068018.

41.

Alanzi

. MHealth for diabetes self-management in the Kingdom of Saudi Arabia: barriers and solutions. J Multidiscip Healthc. 2018;11:535-546. doi:10.2147/JMDH.S174198.

42.

AlOsaimi

Kanan

AlOtaibi

, et al. Assessing intention to use mobile phone–based self-management support among adults with type 2 diabetes in Saudi Arabia: a cross-sectional study. Digit Health. 2025;11:20552076241308993. doi:10.1177/20552076241308993.

43.

Rafiullah

David

. Health apps usage and preferences among Saudi patients with diabetes: a survey. Int J Clin Pract. 2019;73(5):e13345. doi:10.1111/ijcp.13345.

44.

Battelino

Conget

Olsen

, et al. The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial. Diabetologia. 2012;55(12):3155-3162. doi:10.1007/s00125-012-2708-9.

45.

DeSalvo

Miller

Hermann

, et al. Continuous glucose monitoring and glycemic control among youth with type 1 diabetes: international comparison from the T1D Exchange and DPV Initiative. Pediatr Diabetes. 2018;19(7):1271-1275. doi:10.1111/pedi.12711.

46.

Charleer

De Block

Van Huffel

, et al. Quality of life and glucose control after 1 year of nationwide reimbursement of intermittently scanned continuous glucose monitoring in adults living with type 1 diabetes (FUTURE): a prospective observational real-world cohort study. Diabetes Care. 2020;43(2):389-397. doi:10.2337/dc19-1610.

47.

Tourkmani

. The impact of telemedicine on patients with uncontrolled type 2 diabetes mellitus during the COVID-19 pandemic in Saudi Arabia: Findings and implications. J Telemed Telecare. 2021;29(5):390–398.

48.

Haak

Hanaire

Ajjan

Hermanns

Riveline

Rayman

. Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: a multicenter, open-label randomized controlled trial. Diabetes Ther. 2016;8(1):55-73. https://link.springer.com/article/10.1007/s13300-016-0223-6. Accessed August 20, 2025.

49.

Yaron

Roitman

Aharon-Hananel

, et al. Effect of flash glucose monitoring technology on glycemic control and treatment satisfaction in patients with type 2 diabetes. Diabetes Care. 2019;42(7):1178-1184. doi:10.2337/dc18-0166.

50.

Martens

Beck

Bailey

, et al. Effect of continuous glucose monitoring on glycemic control in patients with type 2 diabetes treated with basal insulin. JAMA. 2021;325(22):2262-2272. https://jamanetwork.com/journals/jama/fullarticle/2780593. Accessed August 20, 2025.

51.

Alaqeel

Alabduljabbar

Almutairi

Alqifari

Alaskar

. Glycemic outcomes with insulin pump therapy in Saudi youth with type 1 diabetes. Saudi Med J. 2021;42(1):51-56.

52.

Al Hayek

Robert

Al Dawish

. Assessment of health-related quality of life among Saudi children and adolescents with type 1 diabetes using insulin pump therapy. J Diabetes Res. 2019;35(7):712-717.

53.

Bergenstal

Tamborlane

Ahmann

, et al. Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. N Engl J Med. 2010;363(4):311-320. doi:10.1056/NEJMoa1002853.

54.

REPOSE Study Group. Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE). BMJ. 2017;356:j1285. doi:10.1136/bmj.j1285.

55.

Alaqeel

Alsulaimani

Almanea

, et al. Hybrid closed-loop insulin delivery during Ramadan fasting: a real-world Saudi experience. Diabetes Technol Ther. 2022;24(6):417-423.

56.

Tariq

Hussain

Farooqi

, et al. Use of insulin pump therapy during Ramadan fasting in Muslim patients with type 1 diabetes. Diabetes Ther. 2021;12(4):1093-1105.

57.

Al-Khabbaz

Siddiqui

Alsharidah

Al-Foudri

Al-Ali

. Glycemic control in patients with diabetes using hybrid closed-loop systems during Ramadan in the UAE. Endocr Abstr. 2020;70:AEP338.

58.

Alramadan

Magliano

Almigbal

, et al. Glycaemic control for people with type 2 diabetes in Saudi Arabia—an urgent need for a review of management plan. BMC Endocr Disord. 2018;18(1):62. doi:10.1186/s12902-018-0292-9.

59.

Alshaya

Alsayegh

Alshaya

, et al. The common complications and comorbidities among Saudi diabetic patients in Northern Saudi Arabia. Open J Endocr Metab Dis. 2017;7(7):151-161.

60.

Lipman

. Telemedicine and Diabetes Care in Saudi Arabia and the United Arab Emirates. Economist Intelligence Unit. Economist Impact; 2021. https://www.eiu.com/n/telehealth-in-the-era-of-covid-19/.

61.

Alshahrani

Abdullah

, et al. Prevalence and predictors of diabetic retinopathy in Saudi Arabia: insights from a systematic review and meta-analysis. Biomolecules. 2024;14(12):1486-1486. https://www.mdpi.com/2218-273X/14/12/1486. Accessed January 30, 2025.

62.

Al-Zahrani

AlSwat

AlQarni

, et al. Prevalence and risk factors of diabetic nephropathy among Saudi type-1 diabetic patients in Taif City, Saudi Arabia. Diabetes Metab Syndr Obes. 2023;16:3609-3616. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10642383/. Accessed November 16, 2023.

63.

Abdelwahid

Dahlan

Mojemamy

Darraj

. Predictors of microalbuminuria and its relationship with glycemic control among Type 2 diabetic patients of Jazan Armed Forces Hospital, southwestern Saudi Arabia. BMC Endocr Disord. 2022;22(1):307. https://link.springer.com/article/10.1186/s12902-022-01232-y. Accessed November 16, 2023.

64.

Alfaifi

Abdaly

Ghazwani

Gosadi

. Physicians’ practices in diabetic nephropathy in primary healthcare centers in Jazan City, Saudi Arabia, 2023. Medicina. 2024;60(3):372. doi:10.3390/medicina60030372.

65.

Mustafa Makhdoum

Anas Mahrous

Khalaf Alshareef

Saeid Ghunaim

Osama Abukhodair

Abdulaziz Alburkani

. Knowledge, attitude, and practices regarding diabetic eye disease among general population in Medina City, Saudi Arabia. Open J Ophthalmol. 2024;14(1):18-43. doi:10.4236/ojoph.2024.141003.

66.

Alwazae

Al Adel

Alhumud

Almutairi

Alhumidan

Elmorshedy

. Barriers for adherence to diabetic retinopathy screening among Saudi adults. Cureus. 2019;11(12):e6454. doi:10.7759/cureus.6454.

67.

Al-Ghamdi

Alshoaibi

Aldaadi

, et al. Prevalence and risk factors for diabetic retinopathy in Saudi Arabia: systematic review study. Int J Med Dev Ctries. 2024;8(10):2866-2867. doi:10.24911/IJMDC.51-1724170056.

68.

Hajar

Al Hazmi

Wasli

Mousa

Rabiu

. Prevalence and causes of blindness and diabetic retinopathy in Southern Saudi Arabia. Saudi Med J. 2015;36(4):449–455.

69.

Alghamdi

Tourkmani

Alharbi

Rsheed

Almadani

. Prevalence of retinopathy and associated risk factors among high- and low-risk patients with type 2 diabetes mellitus. Saudi Med J. 2021;42(6):693-697.

70.

Ministry of Health. Legal Regulations for Telehealth Services Ministry of Health-Saudi Arabia Clinical Governance Directorate -DHCOE Legal Regulations for Telehealth Services. Ministry of Health. https://www.moh.gov.sa/en/Ministry/Rules/Documents/Legal-Regulations-for-Telehealth-Services.pdf. Accessed November 16, 2023.

71.

National Health Information Center. Telehealth application guidelines. https://nhic.gov.sa/standards/Telehealth/Telehealth-Application-Guidelines.pdf. Accessed August 20, 2025.

72.

Centers for Medicare & Medicaid Services. Local Coverage Determination (LCD) Glucose Monitors. Centers for Medicare & Medicaid Services; 2024. https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33822. Accessed August 20, 2025.

73.

Yan

Sainz

. CGM and Medicaid: Who’s Covered? diaTribe Change; 2021. https://diatribechange.org/news/cgm-and-medicaid-whos-covered. Accessed August 20, 2025.

74.

Medicare. Advanced diabetes management technology-Medicare medical policy. https://www.providencehealthplan.com/-/media/providence/website/pdfs/providers/medical-policy-and-provider-information/medical-policies/mp25.pdf. Published 2024. Accessed August 20, 2025.

75.

Diabetes Canada. Coverage of Glucose Monitoring Devices. Diabetes Canada; 2022. https://www.diabetes.ca/DiabetesCanadaWebsite/media/Advocacy-and-Policy/Advocacy%20Reports/Glucose-Monitoring-Devices_EN_2022.pdf. Accessed August 20, 2025.

76.

Sainz

. CGM to be Covered by UnitedHealthcare for Adults With Type 2 Diabetes on Insulin. diaTribe; 2023. https://diatribe.org/diabetes-technology/cgm-be-covered-unitedhealthcare-adults-type-2-diabetes-insulin. Accessed February 27, 2025.

77.

Medicare. Therapeutic continuous glucose monitors coverage. https://www.medicare.gov/coverage/therapeutic-continuous-glucose-monitors. Accessed August 20, 2025.

78.

UnitedHealthcare. Continuous glucose monitoring and insulin delivery for managing diabetes. UnitedHealthcare commercial and individual exchange medical policy. https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/continuous-glucose-monitoring-insulin-delivery-managing-diabetes.pdf. Published 2022. Accessed August 20, 2025.

79.

Diabetes Australia. Eligibility expansion for all people with type 1 diabetes to access subsidised CGM and Flash GM products through the NDSS. https://www.ndss.com.au/about-the-ndss/changes-to-the-ndss/. Published 2022. Accessed August 20, 2025.

80.

Centers for Medicare & Medicaid Services. Local coverage determination (LCD) external infusion pumps. https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33794. Published 2024. Accessed August 20, 2025.

81.

Providence Health Plan. Medical policy, reimbursement policy, pharmacy policy, & provider information. https://www.providencehealthplan.com/providers/medical-policy-rx-pharmacy-and-provider-information. Accessed February 27, 2025.

82.

NHS England. Hybrid closed loop technology. https://www.england.nhs.uk/diabetes/digital-innovations-to-support-diabetes-outcomes/hybrid-closed-loop-technology/. Accessed August 20, 2025.

Supplementary Material

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Diabetes Technology in Saudi Arabia: Current Status and Future Directions

Abstract

Background:

Aims:

Methods:

Results:

Conclusion:

Keywords

Background

Materials and Methods

Setting

Methods

Part 1: Narrative review on insulin pumps and CGMs in Saudi Arabia

Part 2: Diabetes technology report

Results

Part 1: Narrative Review on Insulin Pumps and CGMs in Saudi Arabia

The SFDA-approved insulin pumps and CGMs

Continuous glucose monitors

Insulin pumps

Local scientific evidence for the effectiveness, safety, and cost-effectiveness of diabetes technology solutions in Saudi Arabia

Continuous glucose monitors

Insulin pumps

Other diabetes technology solutions

Part 2: Diabetes Technology Report

Patients’ journey to diabetes technology solutions: Navigating the accessibility framework in Saudi Arabia

Public sector

Private sector

Insights from global strategies and best practices

Conclusions (the Roadmap to Improving Accessibility to Diabetes Digital Health in Saudi Arabia)

Supplemental Material

sj-docx-1-dst-10.1177_19322968251370756 – Supplemental material for Diabetes Technology in Saudi Arabia: Current Status and Future Directions

Footnotes

Acknowledgements

Abbreviations

Declaration of Conflicting Interests

Funding

ORCID iDs

Supplemental Material

References

Supplementary Material